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Progress in treating OCD has accelerated in recent years. Effective first-line treatments include behavior therapy and medications, with overwhelming evidence supporting the efficacy of serotonergic reuptake inhibitors (SRIs). Second-line medication treatments for OCD include augmentation of SRIs with neuroleptics, clonazepam, or buspirone, with limited support for other strategies at present. Alternative monotherapies (e.g., buspirone, clonazepam, phenelzine) have more limited supporting data and require further study. Behavior therapy, and perhaps cognitive therapy, is as effective as...

Progress in treating OCD has accelerated in recent years. Effective first-line treatments include behavior therapy and medications, with overwhelming evidence supporting the efficacy of serotonergic reuptake inhibitors (SRIs). Second-line medication treatments for OCD include augmentation of SRIs with neuroleptics, clonazepam, or buspirone, with limited support for other strategies at present. Alternative monotherapies (e.g., buspirone, clonazepam, phenelzine) have more limited supporting data and require further study. Behavior therapy, and perhaps cognitive therapy, is as effective as medication and may be superior in risks, costs, and enduring benefits. Future rigorous research is needed to determine which patients respond preferentially to which medications, at what dose, and after what duration. Emerging treatments include new compounds acting via serotonergic, dopaminergic, glutamatergic, and opioid systems.